UPDATED: 01JAN2009

PORTABLE FIRE EXTINGUISHERS CHECK SHEET

FOR USS ______

DATE: ______

REF: (A) PMS 6641/004

(B) NSTM 079 VOL 2

(C) GSO 555, 602

(D) NSTM 555

/ IAW / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT /
COMPARTMENT NUMBER
OR EQUIPMENT SERIAL NR: /
A. PORTABLE 15 LB CO2 EXTINGUISHERS: / 6641/004
1. Are cylinders properly mounted in shockproof brackets? / M-9R/Q-9R
2. Are the brackets and latching strap in good operational condition? (Bottle should be held firmly) / M-9R/Q-9R
3. Are record tags properly filled out?
- Block 1 = weight of cylinder filled without the hose and horn. - Block 2 = Weight of the hose and horn. - Block 3 = is N/A. - Weight of full cylinder block = is Block 1 and 2 added.
Note: Cylinder 25” or less = cylinder must weigh 40lb or more. Cylinder < the 25” in height must weigh 47lb or more. Stainless steel extinguishers on MCM & MHC no less that 60lb. Aluminum ext. is no less that 32lb.
- Weight on the back of the card is the full weight documented on the front of the card. /

24M-4

M-9R/Q-9R
4. Are recorded preventive maintenance checks within periodicity? R-24/24M-4R/24M-4 Should be the first check listed on the card, followed by the M-9R or Q-9R. /

24M-4

M-9R/Q-9R
5. Are hose and horn assembly in good condition? / M-9R/Q-9R
6. Are cylinders hydrostatically tested as required by PMS? Note: 5 years if cylinder required refilling, 12 years if cylinder is full. / M-9R/Q-9R
7. Is valve handle pull pin and D-ring (if applicable) free of damage and corrosion? / M-9R/Q-9R
8. Are valve safety pins in place and sealed? / M-9R/Q-9R
9. Are there any loose or damaged parts? / M-9R/Q-9R
10. Are extinguisher stowage locations properly marked with photoluminescent markings? / GSO 602, NSTM 079V2
11. Is exposed metallic coupling covered with electrical tape as required by PMS (hose to horn coupling)? / M-9R/Q-9R
12. Is the cylinder of the correct weight? Spot check every 10th extinguisher. /

24M-4

REMARKS:

PORTABLE PKP EXTINGUISHERS

/ IAW / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT /
COMPARTMENT NUMBER:
A. PORTABLE PKP EXTINGUISHERS / 6641/004
1. Are extinguishers properly mounted? / M-2R/Q-7R
2. Are brackets in good operating condition? / M-2R/Q-7R
3. Are valve safety pins in place and sealed and free of corrosion? / M-2R/Q-7R
4. Is the purple decal label band in place and legible? / M-2R/Q-7R
5. Is nozzle and nozzle stowage holder in good condition? (Nozzle should be unobstructed.) / M-2R/Q-7R
6. Is hose free of chafing, kinking, bulges, soft spots, cracking and other physical degradation? / M-2R/Q-7R
7. Is the cylinder in good condition free of dents, abrasions, pitting, cracks, nicks and corrosion? / A-5R, A-18R
8. Is the CO2 cartridge seal unbroken and is the gasket in good condition? (Spot check every 10 PKP bottles checked.) / A-18R
9. Does CO2 plunger move freely? Ensure CO2 cartridge is removed. (Spot check every 10 PKP bottles checked.) / A-18R
10. Is the CO2 cartridge weight sat IAW PMS? (Spot check every 10 PKP bottles checked.) / A-18R
11. Is the PKP chemical dry and powdery? / A-18R
12. Is the PKP at the right fill height? (3 to 5 inches for ANSUL 18# and 27#, FLAG 27#, and LEHAVOT 27#. 5 to 8 inches for FLAG 18# extinguishers. Measured from the lowest thread in the fill opening to the upper surface of PKP powder.) / A-5R
A-18R
13. Are record tags properly filled out? / M-2R/Q-7R, A-5R, A-18R
14. Are recorded preventive maintenance checks within periodicity? / M-2R/Q-7R, A-5R, A-18R
15. Are extinguisher stowage locations properly marked with photoluminescent markings? / GSO 602, NSTM 079V2
REMARKS:

PORTABLE AFFF EXTINGUISHERS:

/ IAW / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT / SAT/ UNSAT /
COMPARTMENT NUMBER:
A. PORTABLE AFFF EXTINGUISHERS: / 6641/004
1. Are extinguishers properly mounted? / Q-10R
2. Are brackets in good operating condition? / Q-10R
3. Are cylinders free of cuts, gouges, corrosion, and abrasion? / Q-10R
4. Are extinguisher stowage locations properly marked with photoluminescent paint as required? / GSO 602, NSTM 079V2
5. Are hose and nozzle in good condition? / Q-10R
6. Is the extinguisher pressure within normal range (within green range on gage)? / Q-10R
7. Are record tags properly filled out?
Note: Front of card: Block 1,2,3 are N/A. Gross Wt placed in “Properly Charged Ext.” block. Back of card: Gross Wt is placed in the Gross Wt block. MRC periodicity is placed in the “periodicity or Wt. CO2/Halon” column. Date and initials in the respective blocks.” Wt is documented to the nearest pound. / Q-10R,
A-1R,
R-48.
8. Is the air-charging cap installed? / Q-10R
9. Are the valve, handle and locking pin free of damage and corrosion? / Q-10R
10. Is there a tamper seal installed in the locking pin? (Locking pin should not be able to be removed without breaking the seal.) / Q-10R
11. Is the hydro test date included on the extinguisher nameplate, hangar loop, or auxiliary metal tag? (Extinguisher shall not be recharged if more than 5 years have elapsed since last hydrostatic test.) / Q-10R
12. Is the AFFF extinguisher of proper weight? (27lbs-9oz to 28 lbs-4ozs) / A-1R
REMARKS:

ASSESSOR(S):______DATE: ______